Chasing Curiosity

Ever since my medical internship – more than 15 years ago – I’ve been obsessed with what is currently called “quality improvement” (for lack of a better term).

Making healthcare better by engaging frontline health workers and enabling them to experiment and collaborate to improve care for patients.And, facilitating transformations in the larger system and culture to enable this work.

Way back in 2008, as a freshly minted doctor – even before I really knew what “QI” was or how to facilitate change – I was bulk emailing PowerPoints, boldly titled “Quality Improvement in Developing Countries.”

In one slide I had written:“Whether or not we can get more resources – we can improve processes.”I have no memory of where I picked up this central notion. I had no formal training in public health, or in quality and safety yet.

I was driven by what I was experiencing in a public tertiary hospital in New Delhi – noticing immense opportunity in the everyday chaos that reigned. From glaring missteps to remarkable camaraderie, and the occasional miracle.I tried to standardise ventilator protocols, improve patient flow in the ER, redesign blood transfusion forms – and more. My amateur efforts often led to naught but sometimes they sparked interest.

I wanted to learn how to work within this constant buzz of human activity – the hospital – the way a baker kneads dough.Taking the chaos of multitudes in a pile of scattered flour, and kneading it into coherence.

I didn’t know then that I would half succeed and half fail at this endeavour. I would never be the baker. This would never be my show. I would not be the one “fixing” things.

I went on to do my Master’s in Public Health, where I developed an out-of-syllabus interest in complexity science – thanks to a chance reading of Black Swan by Nicholas Nassim Taleb.

Instead of writing my thesis on my purported interest in “quality improvement in developing countries” – possibly involving a (boring) survey on medical errors and quality of care – I chose a wild, unusual topic: “Rabies Control from a Complexity Lens.”

Over time, complexity became my lens for understanding health systems and for quality improvement.

This emergent way of connecting disparate areas has stayed with me.Often, what fascinates me is out-of-syllabus.Even now, when everyone is moving towards AI, I am moving towards learning more about writing, art, cinema, and design.

Whenever I learn something new, my mind links it to the systems we work in – and to the people in those systems: health workers, patients, and families. This continued process of gathering ideas, concepts, and resources has become like a wild, overflowing, biodiverse forest in my mind, in scattered notes on my laptop and phone. So much for my original quest for standardisation and coherence!

I would not be a baker – metaphorically or literally. Cooking is not my jam.

Eventually, through some remarkable, understated mentorship, I learnt to make all these fascinating theories practical and simple for health workers.I now love coaching individuals and teams on experimentation, on change, on improvement.I realised how central experimentation is to life.I now even coach friends on fitness, health, or other goals – the principles are universal.#patterns #fractal

I have the incredible privilege to witness others launch their own journeys of transforming the systems they work in – and being transformed themselves.

It is not easy – for me, for others like me who work in QI, or for the health workers who take up this work - of learning new ways of thinking and acting.Projects stall. There are no full-time roles. Funding ends.The need for this work is not understood.Hierarchy often reacts with a vengeance.

Nowadays, many things get called “quality improvement” – and that may be ok.

For me, human agency is the touchstone.Does the way people work together change?Do unusual people start taking centre stage?The indicator graph going up is nice but it is not the main show.The people – the person I work with – will always be more important to me than the numbers.

Perhaps things will change, perhaps this almost 20 year obsession with improving health systems by transforming patterns at the frontline of care – will take new, unexpected shapes.

Nearly 20 years into this journey.I continue to deepen my curiosity.I continue to explore what lies beyond the syllabus.

Photo: Gotjawal Forest, Jeju (South Korea), where I attended an ‘out-of-syllabus’ disaster studies program in 2022.